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Evidence for changing guidelines for routine screening for retinopathy of prematurity
S K Lee1, C Normand, D McMillan
1Canadian Neonatal Network, Canadian Neonatal Network Coordinating Centre, 4480 Oak St, Room E-414, Vancouver, British Columbia V6H 3V4, Canada. shool@interchange.ubc.ca
Insights
Routine screening for retinopathy of prematurity (ROP) can be optimized by focusing on infants with a birth weight (BW) of 1200 g or less. This approach is more cost-effective than current Canadian Pediatric Society (CPS) and American Academy of Pediatrics (AAP) guidelines.
Area of Science:
- Neonatal care
- Ophthalmology
- Public health policy
Background:
- Current guidelines for retinopathy of prematurity (ROP) screening by the Canadian Pediatric Society (CPS) and American Academy of Pediatrics (AAP) are debated.
- Controversy exists regarding the optimal criteria for routine ROP screening in premature infants.
Purpose of the Study:
- To evaluate the cost-effectiveness of different screening strategies for ROP.
- To determine if current ROP screening guidelines require revision based on cost-effectiveness.
Main Methods:
- A cost-effectiveness analysis was performed using data from 16,424 infants admitted to 14 Canadian neonatal intensive care units (NICUs).
- The study compared various birth weight (BW) and gestational age (GA) criteria for ROP screening.
- Data were collected between January 1996 and October 1997.
Main Results:
- Screening infants with a BW of 1200 g or less was the most cost-effective strategy.
- This strategy identified all infants treated for ROP, with a marginal cost per additional person with improved vision of $513,081.
- Compared to current AAP and CPS guidelines, this approach reduced the number of infants screened by 46% and offered significant cost savings.
Conclusions:
- A revised ROP screening strategy focusing on infants with a BW of 1200 g or less is the most cost-effective.
- This approach offers a more efficient method for identifying infants requiring ROP treatment, potentially reducing healthcare costs.
Context:
Existing guidelines recommended by the Canadian Pediatric Society (CPS) and American Academy of Pediatrics (AAP) for routine screening for retinopathy of prematurity (ROP) remain controversial.
Objective:
To determine whether current guidelines for routine screening for ROP should be changed.
Design:
We examined data that were collected as part of a larger study of 14 neonatal intensive care units (NICUs) in Canada. We examined the effect of strategies using different birth weight (BW) and gestational age (GA) criteria for routine ROP screening, and performed a cost-effectiveness analysis.
Setting:
The 14 NICUs (except one) are regional tertiary level referral centres serving geographic regions of Canada, and include approximately 60% of all tertiary-level NICU beds in Canada.
Patients:
This large cohort included all 16 424 infants admitted to 14 Canadian NICUs from January 8, 1996, to October 31, 1997.
Interventions:
None.
Main Outcome Measure:
Treatment for ROP.
Results:
The most cost-effective strategy was to routinely screen only infants having a BW of 1200 g or less. This included all infants treated for ROP (except 1 outlier at 32 weeks GA and 1785 g BW), at a marginal cost per additional person with improved vision of $513 081 for screening patients between 28 weeks GA and 1200 g BW, compared with $1 800 039 and $2 075 874 for using the current AAP and CPS guidelines, respectively (cryotherapy outcomes). Results for laser therapy were similar, but costs were slightly lower. This strategy reduced the number of infants screened under the current CPS guidelines by 46%.
Conclusion:
Screening only infants having a BW of 1200 g or less is the most cost-effective strategy for routine ROP screening.